Since the inception of modern medical practice, the need to transport nonambulatory patients in a safe manner in emergency situations has existed. Presently, transportation of a nonambulatory patient is typically accomplished by use of a wheel chair, if the condition of the patient permits. If not, a gurney or stretcher equipped with wheels may be used to allow the patient to be transported through corridors or the like.
In certain emergency and critical care situations, a patient to be transported may also require a continuous intravenous infusion of blood or an infusion solution, such as 0.9% saline solution, 5% dextrose solution and the like. Typically, the solution for infusion is supplied in a bag or a bottle, which must be suspended above the patient to allow gravity-driven flow of the solution to the patient along intravenous infusion tubing. It is this periodic need to suspend a container of infusion solution above a patient located on a mobile carrier, such as a stretcher, that presents an amazingly complex problem.
Typically a container of intravenous infusion solution must be located from about 2 to about 3 feet above the level of the heart of the patient, to provide for adequate gravity flow of the solution to the patient. It should be readily apparent that having a fixed pole or the like, permanently attached to a mobile carrier, such as a stretcher simply is not a viable approach to the problem.
Although there is need to have a stationary means of holding an intravenous infusion set in place at certain times, at others times there is a dominating need to access the patient. It may be impossible to obtain adequate, critical access to a patient if a permanent device for holding the infusion set is employed. Also, it should be clear that if a fixed stanchion is used to support an intravenous infusion set, its mere physical presence may interfere significantly with a greater need for mobility of the patient.
Faced with the need to support IV infusion devices a substantial height above a patient, while maintaining both mobility as well as flexibility, many solutions have been suggested and some even tried. Exemplary of the previously proposed solutions are the following patents.
U.S. Pat. No. 2,696,963 relates to a portable intravenous fluid carrier designed to be attached to a stretcher or patient bed. The carrier comprises a collapsible pole which, if attached to a stretcher, protrudes outside the perimeter of the stretcher and does not collapse below the plane of the stretcher. Of similar design is U.S. Pat. No. 2,673,771 which relates to an infusion carrier for attachment to hospital stretchers. The infusion carrier comprises a pole which is attached to the stretcher outside the perimeter of the stretcher, presenting a safety hazard due to its unwieldy protrusion from the cart. Additionally, when the pole is collapsed, a substantial lower portion of the pole projects well above the plane of the stretcher, preventing free access to the patient. Such a configuration also is quite impractical for stretchers that must be collapsed for storage, such as the stretchers used in mobile emergency vehicles.
U.S. Pat. No. 2,935,286 relates to an infusion standard for attachment to a patient bed or the like. Although the standard is partially collapsible, it does not collapse below the plane of the bed to which it is attached. Additionally, the point of attachment of the device is outside the perimeter of the bed.
U.S. Pat. No. 2,957,187 relates to a telescoping stand with buttons located at the junctions of the respective pole segments, providing a rapidly releasable design. However, the pole is not used in combination with a stretcher or the like.
U.S. Pat. No. 3,709,372 relates to yet another intravenous supply container support. The ability to vertically adjust the height of the standard is provided by a mounting which permits the standard to be slid upwardly or downwardly and fixed in various positions. The pole, however, cannot be completely collapsed below the plane of the bed.
U.S. Pat. No. 3,709,556 relates to a telescoping IV pole which may be attached to wheel chairs and stretchers. When attached to a stretcher, the vertical standard may be lowered to a position below the plane of the stretcher, but must be fixed in a position outside of the perimeter of the stretcher in order to be raised to a position for supporting an intravenous infusion set. This configuration in operation provides a substantial physical obstacle to access to the patient and increases the effective dimension of the cart, thereby increasing the probability that the pole may accidentally strike a bystander, doorway or other obstruction.
U.S. Pat. No. 4,113,222 relates to a collapsible intravenous pole having a horizontal trigger bar which is centrally pivotally mounted and a clutch which retains the pole at a desired height unless the trigger bar strikes an object, causing the clutch to disengage, allowing the pole to telescope downwardly. The pole is not shown in conjunction with a stretcher and when illustrated in combination with a patient bed, the pole is not situated to collapse below the plane of the bed.
U.S. Pat. No. 4,262,872 relates to a collapsible pole assembly which includes a collapsible pole attached to a stretcher via a coupler to a pivotally mounted shank which allows the pole to be placed in a horizontal position for storage. This configuration does not allow the pole to collapse below the plane of the stretcher.
U.S. Pat. No. 4,541,596 relates to a portable intravenous pole for use in an emergency. The pole is foldable to a compact configuration but, if used in conjunction with a stretcher, it does not store below the plane of the stretcher. Further, the pole is not permanently attached to the stretcher.
U.S. Pat. No. 4,807,837 relates to a portable intravenous stand which is capable of telescoping in height. The stand is not designed for permanent attachment to a stretcher nor for collapsing below the plane of a stretcher to which the pole is attached.
Although some of the foregoing approaches have some degree of viability and potential, the true indication of their worth is their lack of acceptance in the medical profession. The stretcher design in most substantial use today, having the optional capability of supporting an IV infusion set, employs a removable support shaft. In some instances, the shaft is comprised of two hollow tubes, with the top tube being slidably adjustable within the lower tube portion.
A stretcher as described above allows one to remove the pole to provide for accessibility and ease of transportation. However, because the pole is totally removable, it can be easily set aside and misplaced. It is quite apparent that a stretcher which is missing the removable pole cannot support an IV set. Missing IV poles can quickly complicate an already difficult emergency situation and even jeopardize a patient's life. When emergency medical personnel must relegate time to seeking replacement IV poles, critical resources are wasted.
In an emergency situation, one cannot tolerate the possibility that a critically needed IV infusion may be delayed because of the lack of such a support means. From a practical viewpoint, the lack of a support structure for the IV set may mean that a needed critical care technician, such as a nurse, may be required to hold the IV bottle or the like above the patient, making it difficult or impossible for the nurse to also simultaneously render the needed critical care.
Further, misplaced or improperly stored IV poles also present significant potential for personal injury to unwary personnel. As one can imagine, an IV pole thoughtlessly placed on the floor or leaned precariously against a wall or the like, presents a significant safety hazard; yet, emergency medical personnel have as their primary responsibility attending to a patient and not proper storage of IV poles.
It is clear that loss, misplacement, and unavailability of IV poles currently presents substantial problems to the medical community. The expense alone of replacing lost and misplaced IV poles is staggering. Of more significance is the hidden cost of the time lost in trying to locate such missing IV poles.
With the present day approach to solving the problem of IV poles for use with stretchers, even if attendants have the time to follow the manufacturer's directions regarding proper storage of the IV pole, frustration still exists. Because the typical storage location is usually under the stretcher, medical personnel are required to squat, bend or kneel to even determine if the pole has been properly stored. Replacing the pole in the proper storage location also presents the problem in reverse, plus requiring the threading of the pole into the proper storage position, a feat of skill which if not cautiously performed, may endanger unfortunate bystanders in the area. Further, if the pole is not properly stored under the stretcher, injury to personnel may result when the pole falls from the stretcher.
Even if a medical attendant is lucky enough to find a properly stored pole waiting under the stretcher, the problems continue. The pole is taken in hand and the stretcher placed in position to be fitted with the pole. The end of the pole requires insertion into a defined support hole in the stretcher, but the support hole in the stretcher may be obscured by the patient, the mattress, other medical devices or parts thereof, siderails, tubing and the like, making the task frustrating, at best.
The correct placement of the pole into the support hole, under the best of conditions and luck, still requires the use of at least two, and sometimes three, hands. Unfortunately, as the medical technician focuses upon the task at hand, putting the pole into the support hole, enough attention may not be paid to the opposite end of the pole, which typically has a "T" configuration, capable of inflicting severe harm to bystanders and equipment alike.
Another set of problems result from the ability of the pole, in use, to freely rotate. Such free rotation results in the attached tubing winding around the pole, making removal of the IV bag or bottle difficult while placing stress on the connections which may result in inadvertent disruption of the flow of the IV solution to the patient. Also, because of the typical "T" configuration of the top of the pole, if the top is turned so that a support arm projects outwardly, perpendicular to the length of the stretcher, during movement of the patient, the support arm may become caught in doorways, or the like, or may strike passersby.
To date, few meaningful solutions have been suggested to the foregoing problems. At least one company has gone so far as to physically chain the IV pole or its top support portions to the stretcher. That may prevent loss, until someone breaks the chain, but it also introduces other safety problems. The top portion, when not in use, is free-hanging, and may freely swing in a dangerous manner. Also, its mere presence in unwanted locations presents the possibility of medical personnel becoming entangled with the chain of the support portion itself. The chain also causes restrictions in the movement and makes even more difficult and time consuming the task of inserting the pole into the support hole. Additionally, the chain itself poses infection control problems.
When a medical attendant is called upon to place the top portion of the IV pole in place for use, the task presents a potentially dangerous situation. One must be extremely cautious when inserting the pole into the support, not to hit the patient, other attendants, or critical care equipment. In an emergency situation, the problem becomes even more acute as pressure to administer medical care to a patient in need becomes more and more pressing and the magnitude of the problem only worsens.
Another approach to providing IV set support on an as-needed basis employs a pivotable IV pole which is of a one-piece construction. The pole in that design is hinged so that it may be placed in a horizontal position along-side the patient and mattress. That solution solves the problem of loss, but presents its own problems. For example, the patient or mattress may actually be on top of the pole when it is in the horizontal position. If the need then arises to use the pole, the patient, the mattress or both may need to be shifted away from the pole before it can be raised to the vertical position.
The foregoing sometimes presents more of a problem than one might imagine, especially if the patient is nonresponsive and must be physically moved by an attendant. Also, the counterpart problem exists when it becomes necessary to fold the tube down to the horizontal position for storage. If the patient, mattress or both are located over the side where the tube is to be stored, each must be moved before the pole can be stored out of the way.
From all of the foregoing discussion it is quite apparent that a significant need exists for a transportable IV pole and mobile stretcher device which overcomes the problems which have faced the medical profession for so long without solution.